Tuesday, July 15, 2008

Local Heart Doctor

The doctor featured in this article from the "Bellingham Herald" is the main cardiologist that I see at North Cascade Cardiology here in Bellingham. Healthy today, but having been diagnosed with heart failure caused by an idiopathic dialated cardiomyopathy several years ago, he is the main doctor that I go to for check-ups every six months - and anytime in between if it becomes necessary.

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HEALTHLocal heart doctor gains fame

St. Joseph’s Lombardi known for procedure that opens clogged arteries.

Photo by - PHILIP A. DWYER, THE BELLINGHAM HERALDDr. Bill Lombardi, right, performs a chronic total occlusion or CTO procedure at North Cascade Cardiology in Bellingham Friday July 11, 2008. The procedure was watched live via satellite by cardiac physicans at a conference in Seattle. Scrub technologist David Myers assisted.

BELLINGHAM — Using stiff wires the size of human hairs while staring at X-ray images projected onto a screen, heart doctor Bill Lombardi pushed through a Bellingham woman’s totally blocked artery in a procedure that’s gaining him international acclaim.

By the time he finished, Lombardi had guided wires through the passage and inserted stents to prop it open so blood could once again flow normally through 70-year-old Loretta Bollinger’s right coronary artery.

The technique is known as coronary chronic total occlusion intervention. Lombardi, who learned it through pioneering Japanese doctors, has performed at least 350 of these procedures in the past 3½ years — the most of any doctor in the nation.

On Friday, the live-action, X-ray shots of Bollinger’s beating heart and the artery Lombardi was fixing were broadcast live to two giant plasma screens in Seattle, where some 200 of the interventional cardiologist’s peers watched him.

As he worked in a lab owned by St. Joseph Hospital in Bellingham, Lombardi explained what he was doing and fielded questions from doctors attending the annual Science Innovation and Synergy conference. The conference is held each summer in Seattle in coordination with Swedish Medical Center.

Each year, U.S. doctors work on 1 million to 1.3 million patients who have blocked heart arteries. Of that total, 50,000 cases are of totally blocked arteries. But most of the procedures in the U.S., including angioplasty and bypass, are used for partially blocked arteries.

Lombardi is among the few doctors to open totally blocked arteries, for which he is becoming known as a national and international expert.

When arteries are stopped up quickly, it causes a heart attack. When they’re blocked slowly over time, the artery narrows like a river channel and the body grows other blood vessels to keep blood moving through the heart.

“It’s like a scar with calcium and all sorts of evil things in it,” Lombardi explained of the blocked artery. “It becomes very dense and hard. The body, if it happens slowly enough, will build little bridges around the blockage because the body’s good at compensating and wants to keep this heart muscle alive.

“So there will be blood flowing in there but it’s not enough that when you stress the heart or walk fast or do something that people don’t get symptoms,” said Lombardi, who is a partner in North Cascade Cardiology in Bellingham.

For Bollinger, whose artery had been totally blocked for 18 months, those symptoms included being short of breath, some chest tightness and arm pain.

Options for such blockages include medication as well as heart bypass surgery, in which doctors take veins from the legs or arteries from the chest and arms. The chest is opened up and the veins or arteries are sewn on the aorta and around the diseased part of the heart.

The other option is to do a stent procedure, which is what Lombardi did.

“In most of the United States, people get the bypass for this or they get medicine for this. The reason they don’t do interventions is because, as you can imagine, you can see this and you can see this,” Lombardi said while pointing toa drawing of a blocked artery, “but you have no idea what’s going on in here so you’re almost blindly working your way through this blocked segment.”

As Bollinger lay on a table, two catheters — the size of long coffee stir sticks — were inserted into each leg artery at her groin and up to her heart arteries, a distance of about 90 centimeters. Lombardi then pushed what are known as guide wires in through the catheters and to the blocked segment. From there, moving the wires partly by feel and partly by watching the screen, he got them through the blockage.

Once on the other side of the blockage, balloons were inflated, a process known as an angioplasty. That in turn allowed three stents to be permanently embedded into the artery walls.

Made of mesh metal, these stents release medication to keep scar tissue from forming so thickly they close up the heart artery, which is just 2 millimeters to 4 millimeters in size.

The benefit of the procedure is that it’s less invasive than heart bypass surgery. Together with a more complex version of the technique called a retrograde, Lombardi’s center is able to open about 90 percent of all blocked arteries they attempt, he said, and to get blood flowing through them normally again.

“That’s unique to the center,” Lombardi said, adding it was one of the premier centers in the U.S. for this sort of heart therapy.

As for Bollinger she was released to go home on Saturday.

“You’re all fixed. You feeling all right?” Lombardi said to her soon after finishing.

“Yes,” Bollinger replied while still lying on the table.

“I’ll let your family know and you get to go home tomorrow,” he said.

Two days after leaving the hospital, Bollinger said she felt a little sore but was otherwise fine.

In severe heart failure at the time, with an ejection fraction of barely over 10%, this doctor performed a more simplified version of this procedure on me several years ago when my heart was so very, very weak, only to discover that I had no blockages. With no surgical procedures available to help my failing heart, Dr. Lombardi successfully put together a combination of the newest heart medications for me to take each day in an effort to reverse the heart failure and some of the resulting damage to my heart muscle. Test results indicate my ejection fraction to be in the range of 45% to 65% today, indicating to me that those medications worked.

While there is a team of well over 20 excellent cardiologists in that office, and the entire team reviews every patient's folder, I feel Dr. Lombardi is the main doctor responsible for saving my life - and who helps keep me as healthy as possible today.

At my last check-up there, I noticed a large poster on the wall in the waiting room indicating that Dr Lombardi travels to Stanford University to teach some sort of heart surgery procedures class to heart surgeons. Bellingham is fortunate to have him as one of our main cardiologists and I feel so very fortunate to have him as my main cardiologist!